Comparing three machine learning approaches to design a risk assessment tool for future fractures:​ predicting a subsequent major osteoporotic fracture in fracture patients with osteopenia and osteoporosis

de Vries, B. C. S.<sup>1</sup>; Hegeman, J. H.<sup>1,2</sup>; Nijmeijer, W.<sup>1</sup>; Geerdink, J.<sup>3</sup>; Seifert, C.<sup>2</sup>; Groothuis-Oudshoorn, C. G. M.<sup>4</sup>

Affiliations

¹Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands

²Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, The Netherlands

³Department of Information & Organization, Ziekenhuisgroep Twente, Almelo, The Netherlands

⁴Health Technology and Services Research, Techmed Centre, University of Twente, Enschede, The Netherlands

Abstract and keywords

Summary: Four machine learning models were developed and compared to predict the risk of a future major osteoporotic fracture (MOF), defined as hip, wrist, spine and humerus fractures, in patients with a prior fracture. We developed a user-friendly tool for risk calculation of subsequent MOF in osteopenia patients, using the best performing model.

Introduction: Major osteoporotic fractures (MOFs), defined as hip, wrist, spine and humerus fractures, can have serious consequences regarding morbidity and mortality. Machine learning provides new opportunities for fracture prediction and may aid in targeting preventive interventions to patients at risk of MOF. The primary objective is to develop and compare several models, capable of predicting the risk of MOF as a function of time in patients seen at the fracture and osteoporosis outpatient clinic (FO-clinic) after sustaining a fracture.

Methods: Patients aged > 50 years visiting an FO-clinic were included in this retrospective study. We compared discriminative ability (concordance index) for predicting the risk on MOF with a Cox regression, random survival forests (RSF) and an artificial neural network (ANN)-DeepSurv model. Missing data was imputed using multiple imputations by chained equations (MICE) or RSF’s imputation function. Analyses were performed for the total cohort and a subset of osteopenia patients without vertebral fracture.

Results: A total of 7578 patients were included, 805 (11%) patients sustained a subsequent MOF. The highest concordance-index in the total dataset was 0.697 (0.664–0.730) for Cox regression; no significant difference was determined between the models. In the osteopenia subset, Cox regression outperformed RSF (p = 0.043 and p = 0.023) and ANN-DeepSurv (p = 0.043) with a c-index of 0.625 (0.562–0.689). Cox regression was used to develop a MOF risk calculator on this subset.

Conclusion: We show that predicting the risk of MOF in patients who already sustained a fracture can be done with adequate discriminative performance. We developed a user-friendly tool for risk calculation of subsequent MOF in patients with osteopenia.

Keywords: Fracture prediction; Machine learning; Osteopenia; Osteoporosis; Risk assessment; Subsequent fracture

Links

DOI: 10.1007/s00198-020-05735-z

PubMed: 33415373

WoS: 000607213800011

History

Received: 2020-06-29

Accepted: 2020-11-08

Online: 2021-01-07

Cited Works (2)

Year	Entry
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2017	Johansson H, Siggeirsdóttir K, Harvey NC, Odén A, Gudnason V, McCloskey E, Sigurdsson G, Kanis JA. Imminent risk of fracture after fracture. Osteoporos Int. March 2017;28(3):775-780.

Cited By (2)

Year	Entry
2023	Whittier DE, Samelson EJ, Hannan MT, Burt LA, Hanley DA, Biver E, Szulc P, Sornay-Rendu E, Merle B, Chapurlat R, Lespessailles E, Wong AKO, Goltzman D, Khosla S, Ferrari S, Bouxsein ML, Kiel DP, Boyd SK. A fracture risk assessment tool for high resolution peripheral quantitative computed tomography. J Bone Miner Res. September 2023;38(9):1234-1244.
2021	Whittier DEW. The Assessment of Fragility Fracture Risk Using HR-PQCT as a Novel Tool for Diagnosis of Osteoporosis [PhD thesis]. Calgary, AB: University of Calgary; August 2021.